Changing the Script: St. Claire HealthCare's Response to the Opioid Crisis

“The book Dreamland called it a perfect storm,” said Dr. William Melahn, Chief Medical Officer of St. Claire Healthcare, an SND-sponsored ministry in Morehead, KY.

Pain was designated a vital sign. Oxycontin was considered a primary care pain medicine. Cheap heroin was hitting the streets. And pharmaceutical companies were marketing narcotic pain medications as cure-alls. These were the first sparks in the 1990s that set today’s opioid crisis aflame.

Across the nation, families and communities have been impacted by the opioid crisis. Dr. Melahn shared these sobering facts:

The amount of prescription opioids sold to pharmacies, hospitals, and doctors’ offices nearly quadrupled from 1999 to 2010, yet there had not been an overall change in the amount of pain that Americans reported.

Almost 2,000 overdose deaths in Kentucky over the last year.

63,000 people died of overdose in the US in the last year.

Dr. Melahn has followed the statistics closely and has witnessed the tragic cycle of addiction time and again in Eastern Kentucky. He described the cycle as beginning with acute pain treatment that progresses to chronic pain treatment that turns to dependency and results in death.

Policy Changes

In 2012, the Kentucky Legislature passed HB1, a measure that severely regulates the method and process of prescribing pain medication. Dr. Melahn explained that it was a necessary first step in prompting a paradigm shift among healthcare providers. Unfortunately, once patients were cut off from prescriptions, pills were harder to find on the street. Heroin was the next step for many.

This was a pattern St. Claire Healthcare also faced when the medical group decided several years ago that if a physician determined a patient was abusing medication, said patient would not be able to receive a prescription from any St. Claire Healthcare office. The goal was not to terminate these patients. In fact, St. Claire worked to keep patients on board and saw many return for healthcare services. Still, the relationships that continued were not enough; there were too many individuals hooked on pain medication.

As a further commitment to preventing and addressing opioid addiction, St. Claire Healthcare introduced two plans of action.

“We said we will of course follow all rules set forth by the state and will support each other in consistent non-prescription policy,” said Dr. Melahn. “But, we knew we couldn’t just cut patients off. We needed a backup.”

And so, St. Claire Healthcare recruited and hired a physician with expertise in non-medicinal pain intervention. Additionally, the hospital opened an internal clinic for physicians who needed support in caring for patients addicted to opioids. Dr. Melahn, Dr. Cheryl McClain, and Dr. John Sanders staff this clinic and offer de-escalation treatment to taper patients off of pain medications.

Removing the Stigma

The St. Claire Healthcare group recognized that in addition to patient care, there is another component to addressing the opioid crisis: removing the stigma surrounding addiction.

“Eighty percent of people who abuse pain medication started using with a legitimate reason and prescription,” explained Dr. Melahn. “Outreach has been a challenge for St. Claire because we’re dealing with marginalized people and it’s easy for the community to blame them for their own deaths and overdoses due to addiction or accidents.”

Dr. Melahn explained that not every overdose case is the result of abuse. He stated that 500 children in Kentucky accidentally overdosed on a family member’s treatment in the last year and that women aged 55 and older are more likely to die from their legal prescription than any other demographic.

In order to remove the stigma and misunderstandings surrounding opioid addiction, St. Claire Healthcare started in-house and with local first responders. The medical group gave Rowan County fire and police departments supplies of Narcan to shift the focus on saving lives without worry of financial burden. Additionally, medical students at the St. Claire hospital are now being placed in the emergency room during an overdose case, so that they can provide Narcan training to non-fatal overdose patients. Dr. Melahn called it a change in culture.

When asked how this service is a ministry at the margins, Dr. Melahn reflected and said, “It is clearly at the margins because we still hear from so many, ‘Why should you help these people?’ Our response is it is our calling and our role to serve. St. Claire provides a healing ministry to people of Eastern Kentucky. It is obvious giving out opioids is not healing. Instead of walking away from a crisis many healthcare providers helped create, we are working with patients and seeing an impact.”

This article was originally published in the spring 2018 issue of The Pulse, the Sisters of Notre Dame Covington Province newsletter.